Provider Demographics
NPI:1962567552
Name:GORMLEY, KEVIN (ARNP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:GORMLEY
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:GORMLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:2500 ENGLISH CREEK AVE STE 1002
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5519
Mailing Address - Country:US
Mailing Address - Phone:609-833-9933
Mailing Address - Fax:
Practice Address - Street 1:2500 ENGLISH CREEK AVE STE 1002
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5519
Practice Address - Country:US
Practice Address - Phone:609-833-9933
Practice Address - Fax:609-569-1935
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC97974101YM0800X
FLARNP9468054363L00000X
NJ26NJ01447300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner